Chapter 15 Intraoperative Nursing Management (PDF)

Chapter 15 Intraoperative Nursing Management Members of the Surgical Team Patient Anesthesiologist (physician) or certified registered nurse anesthetist (CRNA) Surgeon Nurses Surgical technicians Registered nurse first assistants (RNFAs) or certified surgical technologists (assistant...

Chapter 15 Intraoperative Nursing Management Members of the Surgical Team Patient Anesthesiologist (physician) or certified registered nurse anesthetist (CRNA) Surgeon Nurses Surgical technicians Registered nurse first assistants (RNFAs) or certified surgical technologists (assistants) Copyright © 2022 Wolters Kluwer · All Rights Reserved Surgical Team Roles Circulating nurse Scrub role Surgeon Registered nurse first assistant Anesthesiologist, anesthetist Note: role of nurse as patient advocate Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Is the following statement true or false? The circulating nurse is responsible for monitoring the surgical team. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 True Rationale: The circulating nurse manages the OR and protects the patient’s safety and health by monitoring the activities of the surgical team, checking the OR conditions, and continually assessing the patient for signs of injury and implementing appropriate interventions. Copyright © 2022 Wolters Kluwer · All Rights Reserved Intraoperative Complications Anesthesia awareness Nausea, vomiting Anaphylaxis Hypoxia, respiratory complications Hypothermia Malignant hyperthermia Infection Copyright © 2022 Wolters Kluwer · All Rights Reserved Adverse Effects of Surgery and Anesthesia Allergic reactions, drug toxicity or reactions Cardiac dysrhythmias CNS changes, oversedation, undersedation Trauma: laryngeal, oral, nerve, skin, including burns Hypotension Thrombosis Refer to Chart 15-2 Copyright © 2022 Wolters Kluwer · All Rights Reserved Gerontologic Considerations  Older adult patients are at higher risk for complications from anesthesia and surgery compared to younger adult patients due to several factors: o Age-related cardiovascular and pulmonary changes o Decreased tissue elasticity (lung and cardiovascular systems) and reduced lean tissue mass o Decreases the rate at which the liver can inactivate many anesthetic agents o Decreased kidney function slows the elimination of waste products and anesthetic agents o Impaired ability to increase metabolic rate and impaired thermoregulatory mechanisms Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Is the following statement true or false? The most frequent early sign for a patient at risk for malignant hyperthermia subsequent to general anesthesia is bradycardia. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 False Rationale: The most frequent early sign for a patient at risk for malignant hyperthermia subsequent to general anesthesia is tachycardia. Copyright © 2022 Wolters Kluwer · All Rights Reserved Prevention of Infection Surgical environment o Unrestricted zone: street clothes allowed o Semirestricted zone: scrub clothes and caps o Restricted zone: scrub clothes, shoe covers, caps, and masks Surgical asepsis Environmental controls Refer to Figure 15-3 Copyright © 2022 Wolters Kluwer · All Rights Reserved Basic Guidelines for Surgical Asepsis All materials in contact with the surgical wound or used within the sterile field must be sterile Gowns considered sterile in front from chest to level of sterile field, sleeves from 2 inches above elbow to cuff Sterile drapes are used to create a sterile field. Only top of draped tables are considered sterile Items dispensed by methods to preserve sterility Movements of surgical team are from sterile to sterile, from unsterile to unsterile only Copyright © 2022 Wolters Kluwer · All Rights Reserved Guidelines for Surgical Asepsis Movement at least 1-foot distance from sterile field must be maintained When sterile barrier is breached, area is considered contaminated Every sterile field is constantly maintained, monitored o Items of doubtful sterility considered unsterile Sterile fields prepared as close to time of use The routine administration of hyperoxia (high levels of oxygen) is not recommended to reduce surgical site infections Copyright © 2022 Wolters Kluwer · All Rights Reserved Comparison of Anesthetic Agents and Delivery Systems General Inhalation: Refer to Table 15-1; Figure 15-4 (A, B, C) Intravenous: Refer to Table 15-2 Regional: Refer to Table 15-3 Epidural: Refer to Figure 15-5 Spinal: Refer to Figure 15-5 Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process: Interventions Reducing anxiety Reducing latex exposure Preventing perioperative positioning injury Protecting patient from injury Serving as patient advocate Monitoring, managing potential complications Copyright © 2022 Wolters Kluwer · All Rights Reserved Positioning Factors to Consider Patient should be as comfortable as possible Operative field must be adequately exposed Position must not obstruct/compress respirations, vascular supply, or nerves Extra safety precautions for older adults, patients who are thin or obese, and anyone with a physical deformity Light restraint before induction in case of excitement Copyright © 2022 Wolters Kluwer · All Rights Reserved Laparotomy Position, Trendelenburg Position, Lithotomy Position, and Side- Lying Position for Kidney Surgery Copyright © 2022 Wolters Kluwer · All Rights Reserved Protecting the Patient from Injury Patient identification Monitoring, modifying physical environment Correct informed consent Safety measures (grounding of Verification of records of equipment, restraints, health history, exam not leaving a sedated Results of diagnostic patient) tests Verification, Allergies (include latex accessibility of blood allergy) Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 Through which route are inhaled general anesthetics primarily eliminated? A. Kidneys B. Liver C. Lungs D. Skin Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 C. Lungs Rationale: Gas anesthetic agents are given by inhalation. When inhaled, the anesthetic agents enter the blood through the pulmonary capillaries and act on cerebral centers to produce loss of consciousness and sensation. When anesthetic administration is discontinued, the vapor or gas is eliminated through the lungs. Copyright © 2022 Wolters Kluwer · All Rights Reserved